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FAI – Konzept und Ätiopathogenese

FAI – concept and etiology

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Zusammenfassung

Beim femoroazetabulären Impingement (FAI) handelt es sich um ein neues, zunehmend an Akzeptanz gewinnendes mechanisches Konzept zur Entstehung der Koxarthrose. Dabei können sowohl die Deformität der Hüfte als auch ihre Nutzung zu Schäden führen. Man unterscheidet azetabuläre (Pincer-) und femorale (Cam-)Deformitäten, welche zu charakteristischen Veränderungen des Pfannenrandes führen. Ein Cam-FAI wird v. a. bei aktiven 20- bis 30-jährigen Männern mit weit nach zentral reichenden Knorpelschäden, jedoch meist nur geringen Labrumschäden gesehen, während das Pincer-FAI bei 30- bis 40-jährigen Frauen, mit ausgeprägten Labrumläsionen mit nur randständiger Degeneration des azetabulären Knorpels gefunden wird. Impaktaktivitäten bei Arbeit oder Sport können bereits geringradige FAI-Deformitäten symptomatisch werden lassen. Obwohl für einige FAI-Deformitäten die Ursachen bekannt sind, fehlt für die Mehrzahl der Fälle die Kenntnis der exakten Ursache. Ein besseres Verständnis der Ätiologie des FAI sowie deren Rolle in der Entstehung der Koxarthrose könnte es ermöglichen, die Prävalenz der sog. „primären“ Koxarthrose und deren Folgen zu verringern.

Abstract

Femoroacetabular impingement (FAI), a recently proposed mechanical concept regarding the development of osteoarthritis (OA) of the hip, is gaining increased acceptance. Both osseous deformity and use of the hip may result in hip damage. Osseous deformities are seen on the acetabular (pincer) or the femoral (cam) side of the hip, leading to characteristic alterations of the acetabular rim. Cam FAI is found in 20–30-year-old athletic men, revealing deep cartilage avulsions from the acetabular rim while the labrum is frequently intact. In pincer FAI, found in 30–40-year-old women, the labrum is frequently significantly destroyed with only minor damage to the acetabular rim. Professional or athletic impact activities can trigger even mild FAI deformities to become symptomatic. For some FAI deformities, the etiologies are known, but for most of them the exact causes are unknown. An improved understanding of the etiology of FAI and its role in the development of hip OA might lead to a reduction in the prevalence of so-called primary OA of the hip.

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Literatur

  1. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87: 1012–1018

    Article  PubMed  CAS  Google Scholar 

  2. Chegini S, Beck M, Ferguson SJ (2009) The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: A finite element analysis. J Orthop Res 27: 195–201

    Article  PubMed  Google Scholar 

  3. Dora C, Buhler M, Stover MD et al (2004) Morphologic characteristics of acetabular dysplasia in proximal femoral focal deficiency. J Pediatr Orthop B 13: 81–87

    Article  PubMed  Google Scholar 

  4. Dora C, Mascard E, Mladenov K, Seringe R (2002) Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B 11: 34–40

    Article  PubMed  Google Scholar 

  5. Eijer H, Myers SR, Ganz R (2001) Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 15: 475–481

    Article  PubMed  CAS  Google Scholar 

  6. Eijer H, Podeszwa DA, Ganz R, Leunig M (2006) Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes disease. Hip Int 16: 273–280

    PubMed  CAS  Google Scholar 

  7. Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: An integrated mechanical concept. Clin Orthop Relat Res 466: 264–272

    Article  PubMed  Google Scholar 

  8. Ganz R, Parvizi J, Beck M et al (2003) Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res 417: 112–120

    PubMed  Google Scholar 

  9. Hackenbroch MH Jr, Bruns H, Widenmayer W (1979) Contribution to the etiology of coxarthrosis. Radiographic and clinical evaluation of 976 arthrotic hip joints (author’s transl). Arch Orthop Trauma Surg 95: 275–283

    Article  PubMed  Google Scholar 

  10. Jamali AA, Mladenov K, Meyer DC et al (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: High validity of the „cross-over-sign“. J Orthop Res 25: 758–765

    Article  PubMed  Google Scholar 

  11. Kloen P, Leunig M, Ganz R (2002) Early lesions of the labrum and acetabular cartilage in osteonecrosis of the femoral head. J Bone Joint Surg Br 84: 66–69

    Article  PubMed  CAS  Google Scholar 

  12. Knuesel PR, Pfirrmann CW, Noetzli HP et al (2004) MR arthrography of the hip: Diagnostic performance of a dedicated water-excitation 3D double-echo steady-state sequence to detect cartilage lesions. Am J Roentgenol 183: 1729–1735

    Google Scholar 

  13. Leunig M, Casillas MM, Hamlet M et al (2000) Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71: 370–375

    Article  PubMed  CAS  Google Scholar 

  14. Leunig M, Williams JR, Ganz R (2007) Operative techniques. Sports Med 15: 178–188

    Google Scholar 

  15. Leunig M, Nho S, Turchetto L, Ganz R (2009) Protrusio acetabuli: New insights and experience with joint preservation. Clin Orthop Relat Res (in press)

  16. Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: Surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57: 499–507

    PubMed  Google Scholar 

  17. Li PL, Ganz R (2003) Morphologic features of congenital acetabular dysplasia: One in six is retroverted. Clin Orthop Relat Res 416: 245–253

    Article  PubMed  Google Scholar 

  18. Siebenrock KA, Wahab KH, Werlen S et al (2004) Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 418: 54–60

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor PD Dr. M. Leunig ist für die Firmen Smith & Nephew und Pivot Medical als Berater tätig. Der Autor Prof. Dr. R. Ganz ist für die Firma Smith & Nephew als Berater tätig. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Orthopädie, Untere Extremitäten, Schulthess-Klinik, Lengghalde 2, CH-8008, Zurich, Schweiz

    M. Leunig

  2. Orthopädische Chirurgie, Inselspital, Universität, Bern, Schweiz

    R. Ganz

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  1. M. Leunig
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  2. R. Ganz
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Correspondence to M. Leunig.

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Leunig, M., Ganz, R. FAI – Konzept und Ätiopathogenese. Orthopäde 38, 394–401 (2009). https://doi.org/10.1007/s00132-008-1383-5

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  • DOI: https://doi.org/10.1007/s00132-008-1383-5

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